Sara J. Hyland PharmD
@sarajpharmd.bsky.social
Periop and Emergency Medicine PharmD
| Homesteader, cook, yogi, mama
| Peaceful free-thinker trying to do some good✌
#FOAMed #MedSky #PharmSky
https://scholar.google.com/citations?user=NDd3R3QAAAAJ&hl=en
| Homesteader, cook, yogi, mama
| Peaceful free-thinker trying to do some good✌
#FOAMed #MedSky #PharmSky
https://scholar.google.com/citations?user=NDd3R3QAAAAJ&hl=en
but if deemed only minimal NMB likely, then this need not be accomplished with sug per se.
Guidance from current ASA guidelines is challenging to apply here and evidence very limited in ICU settings 3/
Guidance from current ASA guidelines is challenging to apply here and evidence very limited in ICU settings 3/
June 17, 2025 at 6:30 PM
but if deemed only minimal NMB likely, then this need not be accomplished with sug per se.
Guidance from current ASA guidelines is challenging to apply here and evidence very limited in ICU settings 3/
Guidance from current ASA guidelines is challenging to apply here and evidence very limited in ICU settings 3/
Agree! Love your many prior reviews of this too. Some clips from my recent grand rounds on this topic-
June 10, 2025 at 4:38 PM
Agree! Love your many prior reviews of this too. Some clips from my recent grand rounds on this topic-
June 8, 2025 at 9:38 PM
Patients at High VTE risk (red) comprise a small subgroup and had the highest complication rates overall. These patients appeared to do worst with very short anticoagulant durations or aspirin-only ppx. They saw the lowest complication rates with anticoagulant ppx durations between 2-4 weeks.
January 9, 2025 at 5:43 PM
Patients at High VTE risk (red) comprise a small subgroup and had the highest complication rates overall. These patients appeared to do worst with very short anticoagulant durations or aspirin-only ppx. They saw the lowest complication rates with anticoagulant ppx durations between 2-4 weeks.
Moderate Risk (orange) patients were more heterogeneous, seeing the lowest rates of post-op complications with anticoagulant ppx durations in the range of a few days to a few weeks
January 9, 2025 at 5:43 PM
Moderate Risk (orange) patients were more heterogeneous, seeing the lowest rates of post-op complications with anticoagulant ppx durations in the range of a few days to a few weeks
Here we can see that TJA patients at Routine Risk (green) had very low complication rates with very brief exposures to anticoagulant in favor of aspirin for ppx. Long anticoagulant durations were associated with greater complications, though overall no significant difference in this distribution.
January 9, 2025 at 5:43 PM
Here we can see that TJA patients at Routine Risk (green) had very low complication rates with very brief exposures to anticoagulant in favor of aspirin for ppx. Long anticoagulant durations were associated with greater complications, though overall no significant difference in this distribution.
But what I think is most helpful to bedside clinicians is to see the relationship between the postop complications rate and the duration of anticoagulant ppx (before step down to aspirin monotherapy),
and how this ppx-complication rate relationship is very different for each risk stratum-
and how this ppx-complication rate relationship is very different for each risk stratum-
January 9, 2025 at 5:43 PM
But what I think is most helpful to bedside clinicians is to see the relationship between the postop complications rate and the duration of anticoagulant ppx (before step down to aspirin monotherapy),
and how this ppx-complication rate relationship is very different for each risk stratum-
and how this ppx-complication rate relationship is very different for each risk stratum-
Primary case-control and regression analyses supported many of our included risk factors, preferred VTE ppx agents, and our three-tiered risk stratification. though we could not capture many important risk factors retrospectively unfortunately (smoking status, PT progression, intraop factors etc)
January 9, 2025 at 5:43 PM
Primary case-control and regression analyses supported many of our included risk factors, preferred VTE ppx agents, and our three-tiered risk stratification. though we could not capture many important risk factors retrospectively unfortunately (smoking status, PT progression, intraop factors etc)
We chose a composite primary outcome including both clinically-important thrombotic AND bleeding/wound complications, addressing an important need in developing effective models for risk prediction and precision medicine prescribing.
Needs described well in ICM-VTE journals.lww.com/jbjsjournal/...
Needs described well in ICM-VTE journals.lww.com/jbjsjournal/...
January 9, 2025 at 5:43 PM
We chose a composite primary outcome including both clinically-important thrombotic AND bleeding/wound complications, addressing an important need in developing effective models for risk prediction and precision medicine prescribing.
Needs described well in ICM-VTE journals.lww.com/jbjsjournal/...
Needs described well in ICM-VTE journals.lww.com/jbjsjournal/...
We leveraged our prior institutional database of elective TJA (higher risk/more complex than average elective population) to assess our prescribing tool in a retrospective case-control study with regression analysis. Final analysis included >5000 patients from 2015-2021.
January 9, 2025 at 5:43 PM
We leveraged our prior institutional database of elective TJA (higher risk/more complex than average elective population) to assess our prescribing tool in a retrospective case-control study with regression analysis. Final analysis included >5000 patients from 2015-2021.
We devised our current tool using evidence-based risk factors most pertinent to the modern enhanced recovery era of TJA care. We meld this risk stratification with a step-down approach to VTE ppx that limits exposure to potent anticoagulation only to those patients and periods of greatest risk.
January 9, 2025 at 5:43 PM
We devised our current tool using evidence-based risk factors most pertinent to the modern enhanced recovery era of TJA care. We meld this risk stratification with a step-down approach to VTE ppx that limits exposure to potent anticoagulation only to those patients and periods of greatest risk.
Oldie but goodie ;) I have been reading this and beefing up my workshops r/t this topic 🤓
November 16, 2024 at 1:32 AM
Oldie but goodie ;) I have been reading this and beefing up my workshops r/t this topic 🤓
Latest #EmergencyMedicinePharmacy topic discussion board-
Pharmacotherapy of Acute #STEMI 💔
Special thx to PGY2 @emgpharmd on the assist 💪
#EMedPharmD and/or #PeriopClinicalPharmacist friends- What is your approach?
Pharmacotherapy of Acute #STEMI 💔
Special thx to PGY2 @emgpharmd on the assist 💪
#EMedPharmD and/or #PeriopClinicalPharmacist friends- What is your approach?
January 7, 2025 at 1:01 AM
Latest #EmergencyMedicinePharmacy topic discussion board-
Pharmacotherapy of Acute #STEMI 💔
Special thx to PGY2 @emgpharmd on the assist 💪
#EMedPharmD and/or #PeriopClinicalPharmacist friends- What is your approach?
Pharmacotherapy of Acute #STEMI 💔
Special thx to PGY2 @emgpharmd on the assist 💪
#EMedPharmD and/or #PeriopClinicalPharmacist friends- What is your approach?
Sneak peak below 👀
Many great talks and speakers in this line-up! 💪
Special thanks to everyone leading @ohioshp who pulled this conference together for us amidst everything else going on this year💪💪
Many great talks and speakers in this line-up! 💪
Special thanks to everyone leading @ohioshp who pulled this conference together for us amidst everything else going on this year💪💪
January 7, 2025 at 12:59 AM
Sneak peak below 👀
Many great talks and speakers in this line-up! 💪
Special thanks to everyone leading @ohioshp who pulled this conference together for us amidst everything else going on this year💪💪
Many great talks and speakers in this line-up! 💪
Special thanks to everyone leading @ohioshp who pulled this conference together for us amidst everything else going on this year💪💪
The Dantrium©/Revonto© formulations are reconstituted with 60 mL of sterile water for injection (SWFI) prior to infusion, for routine/scheduled doses.
The Ryanodex© formulation is reconstituted with 5 mL of SWFI prior to IV push administration, for MH emergencies.
The Ryanodex© formulation is reconstituted with 5 mL of SWFI prior to IV push administration, for MH emergencies.
January 7, 2025 at 12:58 AM
The Dantrium©/Revonto© formulations are reconstituted with 60 mL of sterile water for injection (SWFI) prior to infusion, for routine/scheduled doses.
The Ryanodex© formulation is reconstituted with 5 mL of SWFI prior to IV push administration, for MH emergencies.
The Ryanodex© formulation is reconstituted with 5 mL of SWFI prior to IV push administration, for MH emergencies.
➡Albumin is an insoluble protein. It is suspended in NS in commercially-available 5% and 25% concentrations. Albumin can't readily move across the cell wall or mediate fluid shifts at that membrane, hence the isotonicity of both of these fluids is reflective of its carrier.
January 7, 2025 at 12:58 AM
➡Albumin is an insoluble protein. It is suspended in NS in commercially-available 5% and 25% concentrations. Albumin can't readily move across the cell wall or mediate fluid shifts at that membrane, hence the isotonicity of both of these fluids is reflective of its carrier.
In human physiology, we are generally assessing tonicity in terms of fluid behavior at the Intracellular || Extracellular membrane (I.e. the cell wall).
An IVF is termed hypotonic if it causes fluid to shift INTO cells, hypertonic if fluid shifts OUT, isotonic if no fluid shift.
An IVF is termed hypotonic if it causes fluid to shift INTO cells, hypertonic if fluid shifts OUT, isotonic if no fluid shift.
January 7, 2025 at 12:58 AM
In human physiology, we are generally assessing tonicity in terms of fluid behavior at the Intracellular || Extracellular membrane (I.e. the cell wall).
An IVF is termed hypotonic if it causes fluid to shift INTO cells, hypertonic if fluid shifts OUT, isotonic if no fluid shift.
An IVF is termed hypotonic if it causes fluid to shift INTO cells, hypertonic if fluid shifts OUT, isotonic if no fluid shift.
While slightly hyperosmolar, they are both considered isotonic relative to human plasma (osmolarity of 275-295 mOsm/L) since they do not cause cells to shrink nor swell upon infusion.
It's right here in Lexi-Comp if you're feeling betrayed and want quick validation of this.
It's right here in Lexi-Comp if you're feeling betrayed and want quick validation of this.
January 7, 2025 at 12:57 AM
While slightly hyperosmolar, they are both considered isotonic relative to human plasma (osmolarity of 275-295 mOsm/L) since they do not cause cells to shrink nor swell upon infusion.
It's right here in Lexi-Comp if you're feeling betrayed and want quick validation of this.
It's right here in Lexi-Comp if you're feeling betrayed and want quick validation of this.
#TwitteRx-
This kind shout out from a neurologist colleague got me thinking:
What are some of the "non-pharmacy" jobs you've done in your career to help a patient or a colleague?
👀 @GhanaboyPharmd @ChillaPharmD @EMPoisonPharmD @PharmD_intheED @trob_pharmd et al whatchu got?
This kind shout out from a neurologist colleague got me thinking:
What are some of the "non-pharmacy" jobs you've done in your career to help a patient or a colleague?
👀 @GhanaboyPharmd @ChillaPharmD @EMPoisonPharmD @PharmD_intheED @trob_pharmd et al whatchu got?
January 7, 2025 at 12:57 AM
#TwitteRx-
This kind shout out from a neurologist colleague got me thinking:
What are some of the "non-pharmacy" jobs you've done in your career to help a patient or a colleague?
👀 @GhanaboyPharmd @ChillaPharmD @EMPoisonPharmD @PharmD_intheED @trob_pharmd et al whatchu got?
This kind shout out from a neurologist colleague got me thinking:
What are some of the "non-pharmacy" jobs you've done in your career to help a patient or a colleague?
👀 @GhanaboyPharmd @ChillaPharmD @EMPoisonPharmD @PharmD_intheED @trob_pharmd et al whatchu got?
21/21
So always look at the actual event rates and effect size in clinical context when interpreting study results 💪
But first, please use the correct words to describe the results to avoid misinterpreting them and/or spewing misinformation 👍
FIN
Nice quick resource:
So always look at the actual event rates and effect size in clinical context when interpreting study results 💪
But first, please use the correct words to describe the results to avoid misinterpreting them and/or spewing misinformation 👍
FIN
Nice quick resource:
January 7, 2025 at 12:55 AM
21/21
So always look at the actual event rates and effect size in clinical context when interpreting study results 💪
But first, please use the correct words to describe the results to avoid misinterpreting them and/or spewing misinformation 👍
FIN
Nice quick resource:
So always look at the actual event rates and effect size in clinical context when interpreting study results 💪
But first, please use the correct words to describe the results to avoid misinterpreting them and/or spewing misinformation 👍
FIN
Nice quick resource:
16/
This distinction is important because odds will numerically increase much faster than risk. Hence, the relationship between RR and OR is nonlinear.
This distinction is important because odds will numerically increase much faster than risk. Hence, the relationship between RR and OR is nonlinear.
January 7, 2025 at 12:55 AM
16/
This distinction is important because odds will numerically increase much faster than risk. Hence, the relationship between RR and OR is nonlinear.
This distinction is important because odds will numerically increase much faster than risk. Hence, the relationship between RR and OR is nonlinear.
11/
Spend a minute seeing how RR vs. OR compare in this chart summarizing 2 theoretical drug studies that evaluated drug effect on mortality.
Then, decide how many of the statements along the bottom you feel are true.
Spend a minute seeing how RR vs. OR compare in this chart summarizing 2 theoretical drug studies that evaluated drug effect on mortality.
Then, decide how many of the statements along the bottom you feel are true.
January 7, 2025 at 12:55 AM
11/
Spend a minute seeing how RR vs. OR compare in this chart summarizing 2 theoretical drug studies that evaluated drug effect on mortality.
Then, decide how many of the statements along the bottom you feel are true.
Spend a minute seeing how RR vs. OR compare in this chart summarizing 2 theoretical drug studies that evaluated drug effect on mortality.
Then, decide how many of the statements along the bottom you feel are true.
10/
Here's math for those that prefer it:
Here's math for those that prefer it:
January 7, 2025 at 12:55 AM
10/
Here's math for those that prefer it:
Here's math for those that prefer it:
9/
Feeling better about risk vs. odds? Now let's get back to the odds ratio (OR) and how it differs from the risk ratio (a.k.a. relative risk, RR).
RRs (or ORs) are just the ratios of the event RISK (or ODDS) in the comparator population to that of the control population.
Feeling better about risk vs. odds? Now let's get back to the odds ratio (OR) and how it differs from the risk ratio (a.k.a. relative risk, RR).
RRs (or ORs) are just the ratios of the event RISK (or ODDS) in the comparator population to that of the control population.
January 7, 2025 at 12:55 AM
9/
Feeling better about risk vs. odds? Now let's get back to the odds ratio (OR) and how it differs from the risk ratio (a.k.a. relative risk, RR).
RRs (or ORs) are just the ratios of the event RISK (or ODDS) in the comparator population to that of the control population.
Feeling better about risk vs. odds? Now let's get back to the odds ratio (OR) and how it differs from the risk ratio (a.k.a. relative risk, RR).
RRs (or ORs) are just the ratios of the event RISK (or ODDS) in the comparator population to that of the control population.
7/
So a 25% (0.25) lifetime RISK of stroke =
"One-to-three" (1:3, 0.33) lifetime ODDS of stroke,
for smokers in the above theoretical example.
Seeing these measures lined up may add some clarity:
So a 25% (0.25) lifetime RISK of stroke =
"One-to-three" (1:3, 0.33) lifetime ODDS of stroke,
for smokers in the above theoretical example.
Seeing these measures lined up may add some clarity:
January 7, 2025 at 12:54 AM
7/
So a 25% (0.25) lifetime RISK of stroke =
"One-to-three" (1:3, 0.33) lifetime ODDS of stroke,
for smokers in the above theoretical example.
Seeing these measures lined up may add some clarity:
So a 25% (0.25) lifetime RISK of stroke =
"One-to-three" (1:3, 0.33) lifetime ODDS of stroke,
for smokers in the above theoretical example.
Seeing these measures lined up may add some clarity: